Suture bridges

ABSTRACT

The disclosure is directed to a surgical bridge for supporting incision sutures under continuous tension. One form of the surgical bridge comprises an elongated member constructed to bridge the incision, and which is resiliently flexible under the influence of suture tension to compensate for swelling of the incision as it heals. In another form, the bridge includes slotted end guides which are respectively disposed under elevated suture support points, which structure precludes cutting or slicing of the patient&#39;&#39;s skin by the suture itself upon pressured lateral movement of the bridge over the skin surface.

United States Patent [191 Kletselilra et al.

[ Aug. 27, 1974 SUTURE BRIDGES [75] Inventors: Harold D. Kletschka,Minneapolis; Edson H. Rafferty, Excelsior, both of Minn.

[73] Assignee: Bio-Medicus, lnc., Minnetonka,

Minn.

[22] Filed: Nov. 24, 1972 [21] Appl. No.: 309,466

[52] US. Cl. 128/335 [51] Int. Cl A6111 17/04 [58] Field of Search 1.128/334 R, 335

[56] References Cited UNITED STATES PATENTS 815,264 3/1906 Chambersl28/334R 1,852,098 4/1932 Anderson t 128/335 3,014,483 l2/l96l McCarthy128/334 R 3,496,940 2/1970 Steinman 128/335 3/1972 Edwards et a1.128/335 10/1972 Chodorow 128/335 [57] ABSTRACT The disclosure isdirected to a surgical bridge for supporting incision sutures undercontinuous tension. One form of the surgical bridge comprises anelongated member constructed to bridge the incision, and which isresiliently flexible under the influence of suture tension to compensatefor swelling of the incision as it heals. In another form, the bridgeincludes slotted end guides which are respectively disposed underelevated suture support points, which structure precludes cutting orslicing of the patients skin by the suture itself upon pressured lateralmovement of the bridge over the skin surface.

18 Claims, 11 Drawing Figures SUTURE BRIDGES The invention relates tosurgical bridges for supporting incision sutures under continuoustension.

Surgical devices of this general type have existed for some time in anumber of different forms. For example, see the devices disclosed inU.S. Pat. No. 815,264 issued to Joseph E. Chambers on Mar. 13, 1906;U.S. Pat. No. 1,852,098 issued to Alfred W. Anderson on Apr. 5, 1932;and U.S. Pat. No. 3,014,483, which issued on Dec. 26, 1961 to Horace F.McCarthy. With such devices, an incision closing surgical stitch isformed by inserting the suture through the incision under the skin witha surgical needle in the known manner, placing the bridge over theincision relative to the suture, bringing the suture ends around therespective bridge ends and tying them at the middle under the requisitetension.

One problem that has accompanied the formation of surgical stitches withexisting devices is cutting or slicing of the patients skin by thesuture itself as swelling of the incision occurs during the healingprocess. Such swelling tends to force the bridge outwardly, whichincreases suture tension until the adjacent skin gives way and is cut orslit. The same end effect is also caused by pressured movement of thebridge (as by swelling, for example) which carries the suture laterallywith it until the skin gives way. No matter how they occur, skin cuts orslits are a source of major irritation to the patient, and they increasethe possibility of infection before the wound has healed completelywhich can result in the formation of scars.

Our inventive surgical bridge alleviates the problems of excessivesuture tension and resulting skin cuts through the regulation of suturetension and suspension of the suture relative to its point of entry intothe skin. More specifically, one form of our suture bridge comprises anelongated member having skin contacting end portions joined by aconnecting portion constructed to bridge the incision. The suturepierces the skin adjacent the incision in a conventional manner, and isthen brought around each end of the bridge and is-tied or otherwisesecured under proper tension. Of primary significance is making thebridge flexible so that it will resiliently and elastically bend underthe influence of 4 increasing suture tension due to swelling of thewound. In so doing, the bridge compensates and thereby maintains propertension of the suture. Also, when the swelling decreases as the woundheals, the bridge returns to its initial shape and takes up anyloosening to maintain such proper tension.

In another form, our suture bridge comprises a connecting or bridgeportion which elevates the suture support point over a guiding slotwhich completely surrounds the point at which the suture enters theskin. Thus, even though the bridge is moved due to swelling or the like,the slot precludes engagement of the suture by the bridge itself, thusprecluding the suture from being laterally forced against the adjacentskin.

Our invention further contemplates the provision of an individualpre-cut suture and needle for each surgical bridge which may beintegrally formed therewith, to eliminate needless repetition in takingsurgical stitches and to insure maximum convenience and simplicity tothe physician in carrying out his surgical duties.

Other structural features and advantages of our inventive surgicalbridges will become apparent from the description below in conjunctionwith the accompanying drawings.

BRIEF DESCRIPTION OF THE DRAWINGS FIG. 1 is a perspective view of asurgical bridge for supporting incision sutures under proper tension;

FIG. 2 is a sectional view of the suture bridge and suture in place overan incision, taken along the line 2- 2 of FIG. 1; 1

FIG. 3 is the sectional view of FIG. 2 with swollen body tissuesurrounding the incision;

FIG. 4 is a perspective view of an alternative form of the inventivesuture bridge;

FIG. 5 is a sectional view of the suture bridge of FIG. 4 over anincision with a suture in place, taken along the line 55 of FIG. 4;

FIG. 6 is another alternative embodiment of the inventive suture bridge;

FIG. 7 is an enlarged sectional view of the suture bridge of FIG. 6 overan incision with a suture in place, taken along the line 7-7 of FIG. 6;

FIG. 8 is an enlarged perspective view of one end of the suture bridgeof FIG. 6;

FIG. 9 is a perspective view of another alternative embodiment of theinventive suture bridge;

FIG. 10 is a perspective view of another alternative embodiment of theinventive suture bridge; and

FIG. 11 is a fragmentary view of the suture bridge of FIG. 10 in bottomplan.

DESCRIPTION OF THE PREFERRED EMBODIMENT With initial reference to FIGS.1 and 2, a suture bridge embodying the inventive principle isrepresented generally by the numeral 11. Bridge 11 is elongated inshape, having end portions 12 joined by a connecting portion 13constructed to bridge an incision. Each end portion 12 includes a pairof projections 14 which define a slot 15 that serves to guide and retaina suture 16. At the inner most point of the slot 15, bridge 11 includesa thickened region 17 which is rounded to prevent damage to the suture16. I

Connection portion 13 is formed with a gentle curva' ture in thisembodiment which permits it to arch an in cision 18 extending through apatients skin 19 and layers 20 and 21 of deeper tissue. As used hereinincision is intended to encompass wounds, lacerations and the like whichdisrupt normal tissue integrity, as well as openings made for surgicalpurposes. Bridge 11 may be made from any number of materials suitablefor surgical accessories of this type, examples of which are stainlesssteel, nylon and teflon. Of primary importance to the construction ofbridge 11, whatever material from which it is made, is its ability toflex under varying degrees of suture tension, as discussed more fullybelow.

FIG. 2 represents formation of a surgical stitch with the use of asuture bridge 11. With the aid of a surgical needle, suture 16 is passedthrough the skin 19 and layers 20 and 21 of tissue as shown, and thesuture ends are brought through the respective slots 15, over thethickened regions 17 and tied or otherwise secured on top of theconnecting portion 13 under proper tension as shown in FIG. 3.

Under normal circumstances, the tissue surrounding incision 18 undergoesswelling during the healing process. As shown by the broken line andupward arrows in FIG. 3, this swelling may entirely fill the bridgespace and engage the underside of connecting portion 13.

With prior art devices, the result of swelling is increased suturetension, often to the extent that the suture exerts sufficient pressureon the adjacent skin to cause it to give way and be cut or torn. Theflexibility of suture bridge 11, however, permits it to resiliently bendin a compensating manner, thereby precluding suture tension frombecoming excessive to the point of damaging the skin. This significantfeature of the suture bridge 11 also works conversely; i.e., as theswelling of skin surrounding incision 18 decreases, any loosening withinthe suture is automatically tightened by resilient flexibility of thebridge 11 so that proper suture tension is maintained and the surgicalstitch continues to carry out its intended purpose.

With reference to FIGS. 4 and 5, an alternative suture bridge embodyingthe inventive principle is represented generally by the numeral 31.Bridge 31 comprises similar end portions 32 joined by a connectingportion 33. Each of the end portions 32 is similarly formed withprojections 34 defining a slot 35 which is somewhat longer relative tothe slot of bridge 11. The connecting portion 33 is quite different thanthat of bridge 11, having sides which diverge upwardly from therespective end portions 32 and are interconnected by an essentially flattop section. Each of the sides of connecting portion 33 is also formedwith a notch 36 to prevent a suture 37 from slipping off.

As described, it will be appreciated that the suture 37 is supported bythe connecting portion 33 at points elevated or spaced above the skinsurface, and that each of the slots 35 extends inwardly beyond theseelevated support points to preclude engagement of suture 37 by theprojections 34. Broadly speaking, it is the provision of elevatedsupport points coupled with reasonably constructed end portions whichgives rise to the improved structure and use.

Formation of a surgical stitch to close an incision 38 is essentiallythe same; i.e., the suture 37 is introduced through skin and tissuelayers 40 and 41, and its ends are respectively brought through theslots 35 and tied at the top of connecting portion 33. Due to thespecific construction of connecting portion 33, the suture is suspendedbetween the aforementioned elevated support point and the skin 39, andis disposed essentially normal to the skin to reduce the likelihood ofskin tears or cuts. Further, even if swelling of the tissue surroundingincision 38 is appreciable, suture 37 will not be engaged due to therecessed construction of end portions 32, and tearing of the skin byreason of such engagement is precluded.

This improved function occurs whether or not bridge 31 is flexiblyconstructed. Preferably, however, bridge 31 is constructed toresiliently flex under the influence of increased suture tension due toswelling, and such flexure is represented by the broken lines and arrowsin FIG. 5.

FIGS. 6 and 7 disclose an alternative suture bridge 51 which preferablyis resiliently and flexibly constructed,

and also defines elevated suture support points. More specifically,bridge 51 comprises modified end portions 52 and a connecting portion 53essentially the same as connection portion 13 of bridge 11. End portions52 are similar insofar that they include projections 54 definingelongated slots 55. In the preferred case, each of the slots 55 isformed by punching out a supporting tab 56 which bends upwardly and awayfrom the connecting portion 13 in cantilevered fashion. The extreme endof each tab 56 has a slit 57 formed therein which is sized to receiveand frictionally retain any portion of a suture 58. It will beappreciated that the tabs 56 and slits 57 define elevated support pointsfor the suture 58, and that the slots 55 extend inwardly beyond thesesupport points to preclude engagement of the suture 58 at its point ofentry into the skin.

Formation of a surgical stitch with the bridge 51 may be in the mannershown in FIG. 6; i.e., by tying the suture 58 at the top of connectingportion 53 after bringing the suture ends around and through slits 57 oftabs 56. Preferably, tabs 56 are constructed to resiliently flex andbend downwardly with increasing suture tension as swelling occurs, inthe manner described above. Alternatively, and with reference to FIGS. 7and 8, suture 58 may simply be wrapped around the tab 56 and ultimatelythrough slit 57 so that the surgical stitch is held in place withouttying. It will be apparent that the surgeon may simply release thesurgical stitch for removal or adjustment purposes simply by graspingthe free end of suture 58 and removing it from the tab 56.

FIG. 9 depicts form, the bridge 61 of the inventive type in conjunctionwith an individual pre-cut suture 62 and needle 63.

Surgical bridge 61 comprises end portions 64, 65, which are not the sameas in the previous embodiment, and a connecting portion 66 which isessentially the same as that of surgical bridge 11 and 51. A smallaperture is formed through end portion 64 to receive suture componentsare packaged as a unit for maximum convenience and efficiency to thesurgeon.

FIGS. 10 and 11 set forth a surgical bridge similar to the bridge 61 ofFIG. 9, and in which like parts are represented by like numerals withthe letter a added. Bridge 61a differs in that one end of the suture 62ais fused or bonded to the end 64a rather than the knotaperture method ofsecurement. It will be appreciated that suture 620 could be integrallyformed with bridge 61a whether made from the same material, an exampleof which is nylon, or from a different material.

The opposite end of suture 62a is fused or integrally secured to thehead of surgical needle 63a so that all components define an integralunit. This manner of securement of suture 62a to needle 63a isadvantageous because it forms a smaller skin opening in the formation ofa stitch, as compared to the opening formed when the doubled suture 62at the eye of needle 63 passes through the skin.

As shown particularly in FIG. 11, bridge 61a is different in one furtherrespect through its inclusion of a resilient pad on the under surface ofeach of the end portions 640, 65a. In the preferred embodiment, pads 70are formed from a layer of sponge, which offers a better frictionalengagement with the skin surface and also absorbs any secretion from theincision during the healing process.

It will be apparent that the sutures 62 and 62a may be formed fromabsorbable material capable of being assimilated by the body, such aseatgut, or from nonabsorbable material, examples of which are silk andnylon. Similarly, and as suggested above, the several suture bridgesdisclosed herein can also be formed from either type material, whicheveris suitable for a specific application and capable of being constructedin accordance with the inventive principles set forth above. The suturebridges can also be constructed from porous or microporous material tothemselves serve as absorbers of body fluids secreted during the healingprocess, and to better admit air to the incision and thereby hasten thehealing process.

Althrough our inventive suture bridges are disclosed and described foruse in supporting surgical stitches which secure an incision or break ina patients outer layer of tissue or skin, it will be appreciated thatthe devices are equally capable of use in securing deeper layers oftissue and/or structures together.

We claim:

1. A surgical bridge for supporting incision sutures under tension,comprising:

a. a bridge member having first and second end portions joined by aconnecting portion, the end portions being adapted to engage the surfaceof a patients skin on opposite sides of an incision, and the connectingportion being constructed to arch and be spaced from the incision;

b, a pre-cut suture one end of which is secured to the first end portionof the bridge member;

c. a stud member projecting upwardly from the second end portion andhaving a friction notch formed therein for securably receiving theopposite end of the precut suture;

d. said bridge member being constructed to resiliently flex under theinfluence of changing tension within the suture.

2. The device defined in claim 1, wherein the bridge member is elongatedin shape, and each end portion comprises a pair of longitudinallyextending projections defining a slot therebetween to guidably receive asuturc.

3. The device defined in claim 2, wherein the end and connectingportions are of essentially uniform thickness, and further comprising aregion of increased thickness at the inner suture supporting end of theslot, said thickened region being rounded to preclude damage to thesuture.

4. The device defined by claim 1, and further comprising a surgicalneedle for the pre-cut suture.

5. The device defined by claim 4, wherein said opposite end ofthepre-cut suture is integrally secured to the head of the surgical needle.

6. The device defined by claim 1, wherein said one end of the pre-cutsuture is integrally formed with said first end portion.

7. The device defined by claim 1, and further comprising a resilient paddisposed on the under surface of each end portion in a skin engagingposition.

8. The device defined by claim 1, whereinthe bridge member is formedfrom absorbable material capable of being assimilated by the human body.

9. The device defined by claim 1, wherein the bridge member is formedfrom non-absorbable material.

10. The device defined by claim 1, wherein the bridge member is fomiedfrom porous material capable of absorbing body fluids and admitting airto the incision.

1 l. A surgical bridge for supporting incision sutures under tension,comprising:

a. a bridge member having end portions joined by a connecting portion;

b. the end portions being generally flat and adapted to engage thesurface of a patients skin on opposte sides of an incision;

c. the connecting portion being; constructed to bridge the incision andadapted to receive and support a suture over the incision, andcomprising sides which diverge longitudinally of the bridge and upwardlyfrom the plane of the respective end portions and a top section whichinterconnects the sides, the juncture of the top section and each of thesides defining an elevated suture support point which overlies and isspaced from the associated end portion;

d. each end portion having an opening formed therein below theassociated suture support point and sized to preclude engagement of saidend por' tion with the suture.

12. The device defined by claim 11, wherein the bridge member isconstructed to resiliently flex under the influence of changing tensionof a suture supported thereby.

13. The device defined by claim 11, wherein the bridge member iselongated in shape, and each end portion comprises a pair oflongitudinally extending projections, and said opening comprises a slotdefined between said projections.

14. The device defined by claim 11, wherein the connecting portion isnotched at each of said junctures to guidably retain the suture.

15. A surgical bridge for supporting incision sutures under tension,comprising:

a. an elongated bridge member having end portions joined by a connectingportion;

b. the end portions being in part adapted to engage the surface of apatients skin on opposite sides of an incision and said connectingportion being constructed to bridge the incision and adapted to receiveand support a suture over the incision;

0. each end portion comprising a plurality of longitudinally extendingprojections at least one of which is adapted to engage the patients skinsurface, and one of which bends upwardly and away from the connectingportion in cantilever fashion to form a suture support member andelongated opening therebelow through which the suture can pass, theextreme end of each support member defining an elevated suture supportpoint which overlies and is spaced from said elongated opening.

16. The device defined by claim 15, wherein each cantilevered supportmember is constructed to resiliently flex under the influence ofchanging tension within the suture.

17. The device defined by claim 15, wherein each cantilevered supportmember has a frictional slot formed therein to receive and retain thesuture.

18. The device defined by claim 15, wherein the bridge member isresiliently flexible.

1. A surgical bridge for supporting incision sutures under tension,comprising: a. a bridge member having first and second end portionsjoined by a connecting portion, the end portions being adapted to engagethe surface of a patient''s skin on opposite sides of an incision, andthe connecting portion being constructed to arch and be spaced from theincision; b. a pre-cut suture one end of which is secured to the firstend portion of the bridge member; c. a stud member projecting upwardlyfrom the second end portion and having a friction notch formed thereinfor securably receiving the opposite end of the pre-cut suture; d. saidbridge member being constructed to resiliently flex under the influenceof changing tension within the suture.
 2. The device defined in claim 1,wherein the bridge member is elongated in shape, and each end portioncomprises a pair of longitudinally extending projections defining a slottherebetween to guidably receive a suture.
 3. The device defined inclaim 2, wherein the end and connecting portions are of essentiallyuniform thickness, and further comprising a region of increasedthickness at the inner suture supporting end of the slot, said thickenedregion being rounded to preclude damage to the suture.
 4. The devicedefined by claim 1, and further comprising a surgical needle for thepre-cut suture.
 5. The device defined by claim 4, wherein said oppositeend of the pre-cut suture is integrally secured to the head of thesurgical needle.
 6. The device defined by claim 1, wherein said one endof the pre-cut suture is integrally formed with said first end portion.7. The device defined by claim 1, and further comprising a resilient paddisposed on the under surface of each end portion in a skin engagingposition.
 8. The device defined by claim 1, wherein the bridge member isformed from absorbable material capable of being assimilated by thehuman body.
 9. The device defined by claim 1, wherein the bridge memberis formed from non-absorbable material.
 10. The device defined by claim1, wherein the bridge member is formed from porous material capable ofabsorbing body fluids and admitting air to the incision.
 11. A surgicalbridge for supporting incision sutures under tension, comprising: a. abridge member having end portions joined by a connecting portion; b. theend portions being generally flat and adapted to engage the surface of apatient''s skin on opposte sides of an incision; c. the connectingportion being constructed to bridge the incision and adapted to receiveand support a suture over the incision, and comprising sides whichdiverge longitudinally of the bridge and upwardly from the plane of therespective end portions and a top section which interconnects the sides,the juncture of the top section and each of the sides defining anelevated suture support point which overlies and is spaced from theassociated end portion; d. each end portion having an opening formedtherein below the associated suture support point and sized to precludeengagement of said end portion with the suture.
 12. The device definedby claim 11, wherein the bridge member is constructed to resilientlyflex under the influence of changing tension of a suture supportedthereby.
 13. The device defined by claim 11, wherein the bridge memberis elongated in shape, and each end portion comprises a pair oflongitudinally extending projections, and said opening comprises a slotdefined between said projections.
 14. The device defined by claim 11,wherein the connecting portion is notched at each of said junctures toguidably retain the suture.
 15. A surgical bridge for supportingincision sutures under tension, comprising: a. an elongated bridgemember having end portions joined by a connecting portion; b. the endportions being in part adapted to engage the surface of a patiEnt''sskin on opposite sides of an incision and said connecting portion beingconstructed to bridge the incision and adapted to receive and support asuture over the incision; c. each end portion comprising a plurality oflongitudinally extending projections at least one of which is adapted toengage the patient''s skin surface, and one of which bends upwardly andaway from the connecting portion in cantilever fashion to form a suturesupport member and elongated opening therebelow through which the suturecan pass, the extreme end of each support member defining an elevatedsuture support point which overlies and is spaced from said elongatedopening.
 16. The device defined by claim 15, wherein each cantileveredsupport member is constructed to resiliently flex under the influence ofchanging tension within the suture.
 17. The device defined by claim 15,wherein each cantilevered support member has a frictional slot formedtherein to receive and retain the suture.
 18. The device defined byclaim 15, wherein the bridge member is resiliently flexible.